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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 378, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 138, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
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Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 45, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 370, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 337, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 432, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 171, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover American Journal of Ophthalmology
  [SJR: 2.803]   [H-I: 148]   [61 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9394
   Published by Elsevier Homepage  [3123 journals]
  • Eye Drop Dispenser Type and Medication Possession Ratio in Patients With
           Glaucoma: Single-Use Containers Versus Multiple-Use Bottles
    • Authors: Kun-Hoo Na; Chungkwon Yoo; Ji-Hye Park; Yong Yeon Kim
      Pages: 9 - 18
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Kun-Hoo Na, Chungkwon Yoo, Ji-Hye Park, Yong Yeon Kim
      Purpose To determine whether the consumption of topical glaucoma medication is influenced by the type of eye drop dispenser. Design Retrospective cohort study. Methods We examined 366 patients with open-angle glaucoma or ocular hypertension who were bilaterally treated with 0.0015% tafluprost or 2% dorzolamide/0.5% timolol fixed combination (DTFC). The patients were grouped by the type of dispenser and content of eye drops used: (1) tafluprost in bottles (T-Bottle group); (2) tafluprost in unit-dose pipettes (T-Unit group); (3) DTFC in bottles (C-Bottle group); and (4) DTFC in unit-dose pipettes (C-Unit group). We evaluated the medication possession ratio (MPR) among groups, and factors associated with over-consumption (MPR > 1.2) or under-consumption (MPR < 0.8) in multinomial logistic regression. Results The mean MPR was 1.49 (range, 0.69-2.91) in the T-Bottle group, 0.91 (range, 0.32-1.27) in the T-Unit group, 1.25 (range, 0.51-2.60) in the C-Bottle group, and 0.96 (range, 0.36-1.60) in the C-Unit group. The Bottle groups demonstrated higher mean values and wider ranges of MPR compared to the Unit groups. The MPR interval at which the largest number of patients were found was 1.0-1.4 in the Bottle groups and 0.8-1.2 in the Unit groups. Bottle-type dispenser (odds ratio [OR] 64.02), tafluprost medication (OR 2.84), and older age (OR 1.03) were associated with over-consumption, whereas no factor was correlated with under-consumption. Conclusions The type of eye drop dispenser affects the consumption of glaucoma medication. Physicians should consider the type of eye drop dispenser when assessing glaucoma medication adherence.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.011
      Issue No: Vol. 188 (2018)
  • Improving Follow-up and Reducing Barriers for Eye Screenings in
           Communities: The SToP Glaucoma Study
    • Authors: Di Zhao; Eliseo Guallar; Janice V. Bowie; Bonnielin Swenor; Prateek Gajwani; Natasha Kanwar; David S. Friedman
      Pages: 19 - 28
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Di Zhao, Eliseo Guallar, Janice V. Bowie, Bonnielin Swenor, Prateek Gajwani, Natasha Kanwar, David S. Friedman
      Purpose To evaluate factors associated with attendance to follow-up ophthalmic care, and to assess the impact of strategies to improve follow-up. Design Cross-sectional study. Methods This is an ongoing study to develop an eye screening paradigm, focusing on African Americans ≥50 years of age at multiple urban community sites in Baltimore, Maryland. Several strategies were employed aiming to increase follow-up attendance rates. Multivariable logistic regression was used to evaluate the associations between demographic, medical, and ocular factors with follow-up rate. Results The total number of referred patients presenting for a free eye examination (attendance rate) during the first phase, during the second phase, and overall was 686 (55.0%), 199 (63.8%), and 885 (57.0%), respectively. In fully adjusted models, the odds ratio (95% confidence intervals) for attending the follow-up visit was 1.82 (1.19, 2.79) for screening in second phase vs first phase, 0.62 (0.39, 0.99) for screening sites that were 3 to <5 miles vs <1 mile from the hospital, 1.70 (1.12, 2.59) in patients with body mass index ≥ 30 vs < 25 kg/m2, 2.03 (1.28, 3.21) in patients with presenting visual acuity < 20/40 vs ≥ 20/40, and 2.32 (1.24, 4.34) for patients with an abnormal vs normal macula. Conclusions Obesity, short distance between screening sites and hospital, poor presenting visual acuity in the better eye, and an abnormal macula on fundus photography were associated with increased follow-up rate. Implementation of a combination of strategies effectively increased the follow-up rate. Wider adoption of these strategies in other screening programs has the potential to reduce the burden of visual impairment.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.008
      Issue No: Vol. 188 (2018)
  • Assessment of Lamellar Macular Hole and Macular Pseudohole With a
           Combination of En Face and Radial B-scan Optical Coherence Tomography
    • Authors: Masayuki Hirano; Yuki Morizane; Shuhei Kimura; Mio Hosokawa; Yusuke Shiode; Shinichiro Doi; Shinji Toshima; Kosuke Takahashi; Mika Hosogi; Atsushi Fujiwara; Ippei Takasu; Toshio Okanouchi; Masaya Kawabata; Fumio Shiraga
      Pages: 29 - 40
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Masayuki Hirano, Yuki Morizane, Shuhei Kimura, Mio Hosokawa, Yusuke Shiode, Shinichiro Doi, Shinji Toshima, Kosuke Takahashi, Mika Hosogi, Atsushi Fujiwara, Ippei Takasu, Toshio Okanouchi, Masaya Kawabata, Fumio Shiraga
      Purpose To investigate lamellar macular hole (LMH) and macular pseudohole (MPH) using a combination of en face and radial B-scan OCT. Design Retrospective observational case series. Methods Setting : Institutional study. Patient Population : En face and radial B-scan OCT images of 63 eyes of 60 patients diagnosed with LMH or MPH based on an international classification were reviewed. Observation Procedures : Cases were classified using en face images based on the presence/absence of epiretinal membrane (ERM), retinal folds, parafoveal epicenter of contractile ERM (PEC-ERM), and retinal cleavage. We compared the en face imaging–based classification system with the international classification system using radial B-scan images. We quantitatively evaluated visual function and macular morphology. Main Outcome Measures : Characterization of multimodal OCT-based subtypes of LMH and MPH. Results All cases showed ERM and were classified into 4 groups. In the first group, which lacked retinal folds and showed significantly lower visual acuity than the other groups, 81% of eyes had degenerative LMH. In the second group, which lacked PEC-ERM and retinal cleavage and showed significantly lower retinal fold depth, all eyes had MPH. The third group, in which 95% of eyes had symmetric tractional LMH, included eyes with retinal cleavage but without PEC-ERM, and this group showed higher circularity of the foveal aperture and cleavage area than the group with both these features, in which all eyes had asymmetric tractional LMH. Conclusions Multimodal OCT enables classification of LMH and MPH based on pathologic conditions. Retinal traction in particular may be useful for determining treatment methods.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.016
      Issue No: Vol. 188 (2018)
  • Keratoendotheliitis Fugax Hereditaria: A Novel Cryopyrin-Associated
           Periodic Syndrome Caused by a Mutation in the Nucleotide-Binding Domain,
           Leucine-Rich Repeat Family, Pyrin Domain-Containing 3 (NLRP3) Gene
    • Authors: Joni A. Turunen; Juho Wedenoja; Pauliina Repo; Reetta-Stiina Järvinen; Johannes E. Jäntti; Sanna Mörtenhumer; Antti S. Riikonen; Anna-Elina Lehesjoki; Anna Majander; Tero T. Kivelä
      Pages: 41 - 50
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Joni A. Turunen, Juho Wedenoja, Pauliina Repo, Reetta-Stiina Järvinen, Johannes E. Jäntti, Sanna Mörtenhumer, Antti S. Riikonen, Anna-Elina Lehesjoki, Anna Majander, Tero T. Kivelä
      Purpose To describe the phenotype and the genetic defect in keratoendotheliitis fugax hereditaria, an autosomal dominant keratitis that periodically affects the corneal endothelium and stroma, leading in some patients to opacities and decreased visual acuity. Design Cross-sectional, hospital-based study. Methods Patient Population : Thirty affected and 7 unaffected subjects from 7 families, and 4 sporadic patients from Finland. Observation Procedures : Ophthalmic examination and photography, corneal topography, specular microscopy, and optical coherence tomography in 34 patients, whole exome sequencing in 10 patients, and Sanger sequencing in 34 patients. Main Outcome Measures : Clinical phenotype, disease-causing genetic variants. Results Unilateral attacks of keratoendotheliitis typically occurred 1-6 times a year (median, 2.5), starting at a median age of 11 years (range, 5-28 years), and lasted for 1-2 days. The attacks were characterized by cornea pseudoguttata and haze in the posterior corneal stroma, sometimes with a mild anterior chamber reaction, and got milder and less frequent in middle age. Seventeen (50%) patients had bilateral stromal opacities. The disease was inherited as an autosomal dominant trait. A likely pathogenic variant c.61G>C in the NLRP3 gene, encoding cryopyrin, was detected in all 34 tested patients and segregated with the disease. This variant is present in both Finnish and non-Finnish European populations at a frequency of about 0.02% and 0.01%, respectively. Conclusion Keratoendotheliitis fugax hereditaria is an autoinflammatory cryopyrin-associated periodic syndrome caused by a missense mutation c.61G>C in exon 1 of NLRP3 in Finnish patients. It is additionally expected to occur in other populations of European descent.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.017
      Issue No: Vol. 188 (2018)
  • Variation in Intraocular Pressure and the Risk of Developing Open-Angle
           Glaucoma: The Los Angeles Latino Eye Study
    • Authors: Xuejuan Jiang; Mina Torres; Rohit Varma
      Pages: 51 - 59
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Xuejuan Jiang, Mina Torres, Rohit Varma
      Purpose To determine whether measures of intraocular pressure (IOP) variation are independently associated with the risk of developing open-angle glaucoma (OAG). Design A population-based, longitudinal study. Methods A total of 3666 Latinos free of OAG at the baseline of the Los Angeles Latino Eye Study were followed up 4 years later. Maximum IOP, standard deviation (SD) of IOP, range of IOP, and mean IOP were derived from 6 readings obtained at the 2 visits. OAG diagnosis at each visit was based on the consensus of experts who had access to all clinical examination data from that visit. Multivariate logistic regression was performed. Results Maximum, SD, and range of IOP were all associated with risk of developing OAG, and SD and range of IOP remained significantly associated even after adjustment for mean IOP. Maximum IOP provided the best fit to the data and other IOP measures were not associated with OAG risk in the model that had included maximum IOP. The effect of IOP variation varied by the level of IOP. Among participants with higher IOPs (≥15 mm Hg), only higher levels of maximum IOP were associated with a higher OAG risk (P < .05), while SD and range of IOP were not associated with OAG risk. Among participants with lower IOPs (<15 mm Hg), higher levels of maximum, SD, and range of IOP were all associated with a higher risk of developing OAG (P < .05). Mean IOP was associated with OAG risk only in participants with higher IOPs and not in those with lower IOPs. Results were similar when participants were stratified as <18 and ≥18 mm Hg. Conclusions IOP variation was an independent risk factor for OAG. Maximum IOP was the most consistent IOP measure for predicting OAG risk across the entire spectrum of IOPs, possibly by capturing the effect of IOP variation among persons with relative lower IOPs as well as mean IOP effects in those with higher IOPs.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.013
      Issue No: Vol. 188 (2018)
  • A 12-Year Study of Slotted Palladium-103 Plaque Radiation Therapy for
           Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve
    • Authors: Abhilasha Maheshwari; Paul T. Finger
      Pages: 60 - 69
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Abhilasha Maheshwari, Paul T. Finger
      Purpose To present our 12-year experience with low-energy-photon, slotted eye plaque radiation therapy. Design Retrospective interventional case series. Methods Setting : The New York Eye Cancer Center. Study Population : Fifty-two consecutive patients with uveal melanomas near, touching, or surrounding the optic disc. Intervention : Slotted eye plaque radiation therapy. Main Outcome Measures : Change in visual acuity, local tumor control, radiation side effects, eye salvage, and systemic metastases. Results Tumors were peripapillary within 1.5 mm of the optic disc (n = 8, 15%), juxtapapillary touching ≤180 degrees (n = 23, 44%), or circumpapillary >180 degrees and encircling the disc (n = 21, 41%). Mean follow-up was 47 months (median 34 months, range 6-146 months). Radiation induced a mean 41.2% reduction in tumor thickness. Life table analysis showed that 69% of patients retained their visual acuities ≥ 20/40 and had a vision loss–free survival 84 months after treatment. Also, 90% of patients retained their visual acuity between 20/50 and 20/200 and had a vision loss–free survival 36 months after treatment. Slotted plaque brachytherapy was associated with 4% secondary cataract, 11% neovascular glaucoma, and no dry eye or eyelash loss. Local tumor control (no recurrence) was achieved in 98.1% of patients. Life table analysis showed an overall enucleation-free survival of 93% and metastasis-free survival of 94%. Conclusions Slotted plaque radiation therapy provided a normalized plaque-tumor position, such that the entire choroidal melanoma plus a 2- to 3-mm free margin of normal-appearing tissue was included in the targeted zone. At 12 years, slotted plaque radiation therapy resulted in high rates of local tumor control and vision and eye retention.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.025
      Issue No: Vol. 188 (2018)
  • Leadership in Ophthalmology: The Role of Physician-MBAs
    • Authors: Akhilesh S. Pathipati; James C. Tsai
      Pages: 70 - 73
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Akhilesh S. Pathipati, James C. Tsai
      Purpose As American health care evolves, an increasing number of doctors are pursuing MBAs. However, relatively little is known about how business training translates into their future careers. This study characterizes ophthalmologists who have completed MBAs and identifies opportunities for physician leadership in the field. Design Cross-sectional study. Methods We identified 120 ophthalmologists who hold MBAs. We searched each individual's online profiles to collect information on demographics, training, and professional activities. Results Physician-MBAs in ophthalmology are 80% male; 80% are fellowship trained; and 28% are in primarily nonclinical roles and 55% participate in significant nonclinical activity. Hospital administration is most common (31%), followed by pharmaceutical administration (7%) and consulting (5%). Older ophthalmologist-MBAs were more likely to work in nonclinical roles, with 79% of those who completed residency before 2000 engaged in significant nonclinical activity compared to 30% of those who completed residency after 2000. The most common employers of physician-MBAs in ophthalmology are academic medical centers (43%), large group practices (30%), and private practices (13%). Conclusions The majority of ophthalmologist-MBAs work in primarily clinical roles, although a sizable proportion hold nonclinical positions. Moving forward, we anticipate an increased role for physician leaders in health care administration, policy, and entrepreneurship. While formal management training is not necessary for these roles, a growing number of physicians have sought out MBAs to support their nonclinical interests.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.023
      Issue No: Vol. 188 (2018)
  • Correlation Between Ischemic Index of Retinal Vein Occlusion and Oxygen
           Saturation in Retinal Vessels
    • Authors: Irena Šínová; Jiří Řehák; Jana Nekolová; Nad'a Jirásková; Petra Haluzová; Tereza Řeháková; Barbora Bábková; Libor Hejsek; Martin Šín
      Pages: 74 - 80
      Abstract: Publication date: April 2018
      Source:American Journal of Ophthalmology, Volume 188
      Author(s): Irena Šínová, Jiří Řehák, Jana Nekolová, Nad'a Jirásková, Petra Haluzová, Tereza Řeháková, Barbora Bábková, Libor Hejsek, Martin Šín
      Purpose To evaluate the relationship between the ischemic index and the oxygen saturation in retinal vessels in patients with retinal vein occlusion. Design Prospective, cross-sectional study. Methods We performed a prospective study. The cohort consisted of 43 eyes of 43 patients with retinal vein occlusions (RVO), 23 of whom had central retinal vein occlusions (CRVO) and 20 who had branch retinal vein occlusions (BRVO). We evaluated the retinal vessel saturation using an automatic retinal oximetry device. The retinal ischemic index (ISI) was determined using ultra-widefield fluorescein angiography. Results Mean arterial saturation (±SD) was 100% ± 11%, mean vein saturation was 52% ±13%, and mean A-V difference was 48% ± 16% in eyes with BRVO. The average ISI in the same group was 0.48 (range 0-1). There was no statistically significant correlation between the retinal ischemic index and retinal saturation in the BRVO group. The affected eye in the CRVO group had a mean arterial saturation of 101% ± 6%, vein saturation of 44% ± 11 % and A-V difference of 58% ± 10%. The average ISI in the CRVO group was 0.54 (range 0-1). A statistically significant negative correlation between ISI and vein saturation was found in the CRVO group (r = −0.686; P =.0003). A significant positive correlation between ISI and the A-V difference was found in the CRVO group (r = 0.893; P <.0001). Conclusions Oxygen saturation in the retinal vein and the arteriovenous difference correlated with the ischemic index in CRVO patients. No correlation was found for BRVO patients.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.015
      Issue No: Vol. 188 (2018)
  • Evaluating the Usefulness of MP-3 Microperimetry in Glaucoma Patients
    • Authors: Masato Matsuura; Hiroshi Murata; Yuri Fujino; Kazunori Hirasawa; Mieko Yanagisawa; Ryo Asaoka
      Pages: 1 - 9
      Abstract: Publication date: March 2018
      Source:American Journal of Ophthalmology, Volume 187
      Author(s): Masato Matsuura, Hiroshi Murata, Yuri Fujino, Kazunori Hirasawa, Mieko Yanagisawa, Ryo Asaoka
      Purpose The purpose of the current study was to evaluate the test-retest reproducibility and structure-function relationship of the MP-3 microperimeter, compared against the Humphrey Field Analyzer (HFA). Methods Design : Reliability and validity study. Setting : Institutional, or clinical practice. Study Population : Thirty eyes of 30 primary open-angle glaucoma patients were enrolled. Observation Procedures : Visual fields (VF) were measured twice with the MP-3 and HFA instruments, using the 10-2 test grid pattern in both perimeters. Ganglion cell complex (GCC) thickness was measured using optical coherence tomography (OCT). Test-retest reproducibility was assessed using the mean absolute deviation (MAD) measure at all 68 VF test points, and also the intraclass correlation coefficient (ICC) of the repeated VF sensitivities. The structure-function relationship between VF sensitivities (measured with MP-3 or HFA) and GCC thickness (adjusted for the retinal ganglion cell displacement) was analyzed using linear mixed modeling. Main Outcome Measure : Reproducibility and structure-function relationship. Results The average measurement duration with the HFA 10-2 was 7 minutes and 6 seconds (7m06s) ± 0m49s (mean ± standard deviation). A significantly (P < .001, paired Wilcoxon test) longer measurement duration was observed for the MP-3 test: 10m29s ± 2m55s. There were no significant differences in MAD and ICC values between HFA (MAD; 0.83 ± 0.69 dB and ICC: 0.89 ± 0.69, mean ± standard deviation) and MP-3 (MAD: 0.65 ± 0.67 dB and ICC: 0.89 ± 0.69). MP-3 VF sensitivities had a stronger structure-function relationship with GCC thickness compared to HFA. Conclusions The MP-3 microperimeter has a similar test-retest reproducibility to the HFA but a better structure-function relationship.

      PubDate: 2018-01-03T12:22:36Z
      DOI: 10.1016/j.ajo.2017.12.002
      Issue No: Vol. 187 (2018)
  • Characteristics and Visual Outcome of Refractory Retinal Vasculitis
           Associated With Antineutrophil Cytoplasm Antibody–Associated
    • Authors: Miaoli Lin; Stephen D. Anesi; Lina Ma; Aseef Ahmed; Karen Small; C. Stephen Foster
      Pages: 21 - 33
      Abstract: Publication date: March 2018
      Source:American Journal of Ophthalmology, Volume 187
      Author(s): Miaoli Lin, Stephen D. Anesi, Lina Ma, Aseef Ahmed, Karen Small, C. Stephen Foster
      Purpose To describe the clinical characteristics, therapies, visual outcomes, and prognoses of patients with retinal vasculitis associated with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). Design Retrospective case series. Methods Patients diagnosed with retinal vasculitis associated with AAV and at least 6 months of follow-up were included. Demographic data, systemic and ocular features, best-corrected visual acuity at the initial visit and latest visit, fluorescein angiography (FA) and indocyanine green angiography (ICGA) findings, therapy regimen, and outcome were collected from the Massachusetts Eye Research and Surgery Institution (MERSI) database from 2006 to 2017. Results Fourteen patients (22 eyes) were identified. Twelve had granulomatosis with polyangiitis (GPA) and 1 each had microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). FA showed that AAV affected small-to-medium-size retinal vessels. Seven cases (50%) had both vein/venule and artery/arteriole involvement. Four cases co-presented with choroidal vasculitis. All of them failed various immunomodulatory therapies prior to referral to MERSI. Six patients received rituximab plus prednisone as their final therapy and 5 of them achieved remission. Four patients who failed cyclophosphamide previously were induced into remission by rituximab. Patients were followed for 33.4 ± 25.5 (range 6–84) months. Nine of 14 patients (64.3%) achieved remission at their latest visit. Seventeen of 22 eyes (77.3%) met the criteria for a good (≥20/40) visual outcome. Conclusion The majority of patients enjoyed a good visual outcome and achieved remission after aggressive treatment. Rituximab should be considered as an initial treatment for patients with refractory retinal vasculitis associated with AAV.

      PubDate: 2018-01-10T15:39:00Z
      DOI: 10.1016/j.ajo.2017.12.004
      Issue No: Vol. 187 (2018)
  • Prevalence and Characteristics of Myopic Degeneration in an Adult Chinese
           American Population: The Chinese American Eye Study
    • Authors: Farzana Choudhury; Stacy M. Meuer; Ronald Klein; Dandan Wang; Mina Torres; Xuejuan Jiang; Roberta McKean-Cowdin; Rohit Varma; Rohit Varma; Roberta McKean-Cowdin; Stanley P. Azen; Mina Torres; Chunyi Hsu; David Dinh; Ruzhang Jiang; Jie Sun; Dandan Wang; YuPing Wang; Justine Wong; Shuang Wu; Rucha Desai; Lisa V. John; Michelle Cheng
      Pages: 34 - 42
      Abstract: Publication date: March 2018
      Source:American Journal of Ophthalmology, Volume 187
      Author(s): Farzana Choudhury, Stacy M. Meuer, Ronald Klein, Dandan Wang, Mina Torres, Xuejuan Jiang, Roberta McKean-Cowdin, Rohit Varma
      Purpose To characterize and provide population-based prevalence estimates of myopic degeneration (MD) among Chinese Americans, the fastest-growing minority population in the United States in the last decade. Design Population-based, cross-sectional study. Methods A total of 1523 Chinese-American adults with myopia, aged 50 years and older, residing in the city of Monterey Park, California, underwent an interview and comprehensive eye examination, including subjective and objective refraction and stereoscopic fundus photography. For each participant, the eye with the worse myopic refractive error was included in this analysis. MD was assessed in a masked manner by an expert grader. Results The prevalence of any MD was 44.9% among myopic subjects, based on the presence of any degenerative lesion secondary to myopia. The prevalence was 32.2% when MD was defined by a modified version of the Meta-Analysis for Pathologic Myopia. The prevalence of specific lesions included tessellation (31.7%), tilted disc (28.1%), peripapillary atrophy (7.0%), staphyloma (5.7%), diffuse atrophy (6.4%), lacquer cracks (2.6%), intrachoroidal cavitation (2.2%), patchy atrophy (0.9%), and end-stage MD (0.2%). The prevalence of MD was higher among older myopic subjects and among participants with more severe myopia and longer axial length (P < .001). Conclusions These data provide the first population-based estimates of MD in Chinese Americans and indicate that a high proportion of Chinese Americans might be at risk for MD and associated visual complications. Prevalence of MD in this cohort of Chinese Americans was higher than that observed in other East Asian populations and in people of other ethnicities.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.010
      Issue No: Vol. 187 (2018)
  • Comparison of Changes in Macular Ganglion Cell–Inner Plexiform Layer
           Thickness Between Medically and Surgically Treated Eyes With Advanced
    • Authors: Hiroko Inuzuka; Akira Sawada; Tetsuya Yamamoto
      Pages: 43 - 50
      Abstract: Publication date: March 2018
      Source:American Journal of Ophthalmology, Volume 187
      Author(s): Hiroko Inuzuka, Akira Sawada, Tetsuya Yamamoto
      Purpose To compare changes in the macular ganglion cell layer and inner plexiform layer (mGCIPL) thickness over 5 years between surgically treated eyes (STE) and medically treated eyes (MTE) with advanced glaucoma. Design Retrospective, comparative case series. Methods Eighty-six patients comprising 43 with open-angle glaucoma (OAG) with trabeculectomy and 43 with medically treated OAG. The mGCIPL thickness was measured more than 5 times during follow-up by optical coherence tomography. Main outcome measure was differences in mGCIPL thickness thinning rate between the groups. Results The mean age at study initiation was 62.5 ± 9.2 years in STE and 62.7 ± 9.5 years in MTE. The mean deviations (MD), according to the Humphrey Field Analyzer central program 30-2, and the mGCIPL thickness in each sector showed no significant differences at initial measurement. The averaged intraocular pressure (IOP) throughout follow-up was 10.5 ± 2.0 mm Hg in STE and 10.8 ± 0.8 mm Hg in MTE (P = .429; Mann-Whitney U test). There was no significant difference in the MD changes over 5 years between the 2 groups (P = .405; Mann-Whitney U test). Changes in the mGCIPL thickness over 5 years in MTE were significantly greater than that in STE in all sectors (all 6 sectors P < .0001, Mann-Whitney U test). The IOP fluctuation over 5 years in STE was significantly less than that in MTE (P < .0001, Mann-Whitney U test). Conclusions The structure of the mGCIPL was better preserved in STE than in MTE, even when the IOPs during follow-up were similar.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.012
      Issue No: Vol. 187 (2018)
  • Identification of Herpes Zoster–Associated Temporal Arteritis Among
           Cases of Giant Cell Arteritis
    • Authors: Erin M. Buckingham; Maria A. Foley; Charles Grose; Nasreen A. Syed; Morton E. Smith; Todd P. Margolis; Matthew J. Thurtell; Randy Kardon
      Pages: 51 - 60
      Abstract: Publication date: March 2018
      Source:American Journal of Ophthalmology, Volume 187
      Author(s): Erin M. Buckingham, Maria A. Foley, Charles Grose, Nasreen A. Syed, Morton E. Smith, Todd P. Margolis, Matthew J. Thurtell, Randy Kardon
      Purpose To examine whether herpes zoster antigen (also called varicella-zoster virus antigen) was detectable in temporal artery biopsies taken from individuals with giant cell arteritis (GCA). Design Retrospective comparative case series. Methods Sections of formalin-fixed paraffin-embedded temporal arteries were examined first by hematoxylin-eosin (H&E) staining to establish the diagnosis of GCA. Adjacent sections of the same biopsy were then examined by immunohistochemistry, using 2 different monoclonal antibodies against a major antigen of varicella-zoster virus called gE. Pathologic specimens were obtained from patients cared for at the University of Iowa and Washington University in St. Louis ophthalmology clinics. Results The study included biopsies from 25 patients with symptoms of GCA as well as positive H&E pathology and 25 patients with symptoms compatible with GCA but negative H&E pathology. Among the GCA-positive group, 3 patients had positive staining for herpes zoster antigen. Among the GCA-negative group, herpes zoster antigen was not detected in any biopsy. In both groups of patients, false-positive staining for herpes zoster antigen was detected in the presence of calcifications in the arteries. False-positive staining was also detected on some extra-arterial skeletal muscle and erythrocytes. Conclusion Herpes zoster antigen was detected in 3 of 25 temporal arteries from patients with biopsy-proven GCA. One of the 3 positive cases was noteworthy because the patient had had herpes zoster ophthalmicus diagnosed 3 weeks before the onset of GCA symptoms. False-positive staining for herpes zoster antigen was detected on several temporal artery biopsies.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.017
      Issue No: Vol. 187 (2018)
  • Retinal Vascular Impairment in Best Vitelliform Macular Dystrophy Assessed
           by Means of Optical Coherence Tomography Angiography
    • Authors: Maurizio Battaglia Parodi; Francesco Romano; Maria Vittoria Cicinelli; Alessandro Rabiolo; Alessandro Arrigo; Luisa Pierro; Pierluigi Iacono; Francesco Bandello
      Pages: 61 - 70
      Abstract: Publication date: March 2018
      Source:American Journal of Ophthalmology, Volume 187
      Author(s): Maurizio Battaglia Parodi, Francesco Romano, Maria Vittoria Cicinelli, Alessandro Rabiolo, Alessandro Arrigo, Luisa Pierro, Pierluigi Iacono, Francesco Bandello
      Purpose To evaluate vascular abnormalities at superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) in patients with Best vitelliform macular dystrophy (BVMD) by means of optical coherence tomography angiography (OCT-A). Design Cross-sectional case series. Methods Sixty-six eyes of 33 patients with BVMD (16 male) and 33 controls were consecutively enrolled. Patients were subdivided into classic stages and underwent best-corrected visual acuity (BCVA), fundus autofluorescence and spectral domain-optical coherence tomography, and 4.5 × 4.5-mm swept-source OCT-A. Choroidal neovascularization (CNV) and capillary dilations were qualitatively assessed by 2 masked ophthalmologists. Each OCT-A slab was imported into ImageJ 1.50 and digitally binarized for quantitative analyses. Foveal avascular zone (FAZ) area was measured manually; vessel density was then quantified after the exclusion of the FAZ pixels. Eyes classified as stages 3 and 4 were evaluated together. Results Nineteen eyes (28.8%) revealed capillary dilations at DCP, 15 of which were in stages 1 and 2. Interestingly, CNV was detected in 24 eyes (36.4%). Quantitative analysis disclosed that stages 3–4 and 5 carry significant impairment at both SCP (P < .0001 and P = .02, respectively) and DCP (P < .0001 and P = .0004, respectively) compared to controls. FAZ area was enlarged at the DCP (P = .001). Only DCP vessel density significantly correlated with the stage and BCVA. Conclusions Patients with BVMD show significant vascular impairment at both superficial and deep retinal plexuses, correlating with functional outcomes. These findings, especially at DCP, may improve our understanding about the pathogenesis, and may help in predicting BVMD treatment efficacy.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.013
      Issue No: Vol. 187 (2018)
  • Physician Assistants and Nurse Practitioners in Ophthalmology—Has
           the Time Come'
    • Authors: David J. Browning
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): David J. Browning

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.09.023
      Issue No: Vol. 186 (2018)
  • History of the American Journal of Ophthalmology: A 100th Anniversary
    • Authors: Michael W. Stewart; Sarah L. Duncan Powers; Richard K. Parrish
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Michael W. Stewart, Sarah L. Duncan Powers, Richard K. Parrish

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.10.030
      Issue No: Vol. 186 (2018)
  • Evolving Concepts in the Management of Retinopathy of Prematurity
    • Authors: Paul Sternberg; Alia K. Durrani
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Paul Sternberg, Alia K. Durrani
      Purpose The introduction of anti–vascular endothelial growth factor (VEGF) agents has stimulated considerable reexamination of treatment strategies for the management of retinopathy of prematurity (ROP). Herein we summarize and review evolving concepts and provide a personal perspective on clinical management today and future directions of treatment. Design Literature review. Methods To synthesize the evolving management concepts for diagnosis and treatment of retinopathy of prematurity and to provide interpretation and perspective on current emerging therapies. Results Although initial treatment strategies focused on ablative therapy for threshold ROP, earlier treatment for type 1 or pre–threshold disease has been found to decrease unfavorable visual and structural outcomes. Vascular endothelial growth factor has emerged as a significant contributor to retinal-vascular diseases in the previous 2 decades. The potential role of anti-VEGF treatment for type 1 ROP has become a focus in recent years, but the protracted recurrence of disease and unknown adverse ocular and systemic effects have caused concern from some clinicians. In addition, the use of telemedicine technologies may provide the ability to screen remote areas with a shortage of ROP providers, thereby reducing the burden of disease. Conclusions The diagnosis and management of ROP has changed over the past 40 years; the role of anti-VEGF therapy remains to be established in current treatment strategies. Screening for initial disease and progression will likely be impacted by the increasing prevalence of telemedicine and relative shortage of clinicians.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.10.027
      Issue No: Vol. 186 (2018)
  • Fluorouracil Filtering Surgery Study One-Year Follow-up
    • Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): The Fluorouracil Filtering Surgery Study Group
      Two hundred thirteen patients participated in the Fluorouracil Filtering Surgery Study, a randomized clinical trial, to determine the efficacy and safety of subconjunctivally injected 5-fluorouracil after filtering surgery in eyes with poor prognoses. Twenty-eight (27%) of the 105 eyes in the 5-fluorouracil group and 54 (50%) of the 108 eyes in the standard group were classified as failures, defined by reoperation for control of intraocular pressure during the first year or an intraocular pressure greater than 21 mm Hg at the one-year visit (P = .0007, Mantel-Haenszel chi-square). Corneal epithelial toxicity and transient visual acuity loss were more common in the 5-fluorouracil group (P < .001, chi-square); however, the visual acuities and the mean visual field sensitivities were not significantly different at one year. We recommend the use of subconjunctivally injected 5-fluorouracil after trabeculectomy in eyes with uncontrolled glaucoma and poor prognoses, specifically after previous cataract extraction or unsuccessful filtering surgery.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.021
      Issue No: Vol. 186 (2018)
  • Longitudinal Change in Central Corneal Thickness in the Tema Eye Survey
    • Authors: Jean-Claude Mwanza; Samantha E. Tulenko; Donald L. Budenz; Elizabeth Mathenge; Leon H. Herndon; Hanna Y. Kim; Alyson Hall; Graham Hay-Smith; Alexander Spratt; Keith Barton
      Pages: 10 - 18
      Abstract: Publication date: Available online 12 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Jean-Claude Mwanza, Samantha E. Tulenko, Donald L. Budenz, Elizabeth Mathenge, Leon H. Herndon, Hanna Y. Kim, Alyson Hall, Graham Hay-Smith, Alexander Spratt, Keith Barton

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.11.002
      Issue No: Vol. 186 (2018)
  • Orbital Frontal Nerve Schwannoma—Distinctive Radiological Features
    • Authors: Stephanie Ming Young; Yoon-Duck Kim; Gang Seok Jeon; Kyung In Woo
      Pages: 41 - 46
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Stephanie Ming Young, Yoon-Duck Kim, Gang Seok Jeon, Kyung In Woo
      Purpose To review the radiological findings of frontal nerve schwannoma of the orbit and determine distinguishing imaging features. Design Retrospective interventional case series. Methods Setting : Single tertiary institution. Period : September 1996 to December 2016. Patient Population : Thirteen patients with orbital frontal nerve schwannoma. Intervention : Patients underwent surgical excision following preoperative imaging. Main Outcome Measures : Imaging characteristics on computed tomography (CT) and magnetic resonance imaging (MRI). Results There were 13 patients with histopathologically proven schwannoma of the frontal nerve. Mean age was 44.4 years and 61.5% were male. The majority (84.6%) of frontal nerve schwannomas extended between the supraorbital notch and superior orbital fissure. The most common shape seen in our patients with frontal nerve schwannoma was a multilobulated “beaded” appearance (46.2%), followed by a dumbbell (30.8%), oval (15.4%), and fusiform (7.7%) shape. On CT imaging, all patients had bony remodeling. Target sign, fascicular sign, and cystic degeneration were seen in 76.9%, 35.8%, and 46.2% of patients, respectively. On radiological-pathologic correlation, the zone of tightly packed cellular solid portion (Antoni A pattern) corresponded to the hypointense area on T2-weighted MRI and the hyperintense area on gadolinium-enhanced T1-weighted MRI. Conclusion Frontal nerve schwannoma should be considered as a differential diagnosis for any superior orbital mass. Our study describes several radiological findings that would point toward its diagnosis, including its multilobulated beaded or dumbbell shape, as well as additional signs such as the target sign, fascicular sign, and cystic degeneration.

      PubDate: 2018-01-03T12:22:36Z
      DOI: 10.1016/j.ajo.2017.11.012
      Issue No: Vol. 186 (2018)
  • Long-term Outcome of Second Ahmed Valves in Adult Glaucoma
    • Authors: Nima Fatehi; Esteban Morales; Nucharee Parivisutt; Reza Alizadeh; Grace Ang; Joseph Caprioli
      Pages: 96 - 103
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Nima Fatehi, Esteban Morales, Nucharee Parivisutt, Reza Alizadeh, Grace Ang, Joseph Caprioli
      Purpose To evaluate the long-term outcomes of second Ahmed glaucoma valve (AGV) implants in eyes with glaucoma. Design Retrospective interventional case series. Methods Patients with sequential second Ahmed valves implanted in the same eye from 1994 to 2016 were included. Success was defined with 3 criteria: (1) intraocular pressure (IOP) ≤ 21 mm Hg and IOP reduction of 20%; (2) IOP ≤ 18 mm Hg and IOP reduction of 25%; and (3) IOP ≤15 mm Hg and IOP reduction of 30%. The primary analysis was the 5-year Kaplan-Meier survival rate for each criterion. Failure was established when the success criterion was not met at 2 consecutive visits at least 3 months after the surgery. Loss of light perception, requirement for additional glaucoma surgery, hypotony maculopathy, and serious complications were also considered failures. Results One hundred ten eyes from 104 patients were included with a mean follow-up of 5.0 years (interquartile range [IQR] 1.6–7.33 years). The median (IQR) age at the second AGV was 68.0 (53.5–77.9) years. The median (IQR) time between surgeries was 2.1 (0.7–4.0) years. The 5-year Kaplan-Meier survival rates were 57%, 51%, and 30% for criteria 1, 2, and 3, respectively. Conclusion A second AGV is effective in reducing IOP in patients who require additional IOP lowering after a first AGV. The success rates are comparable to primary AGV implantation, and to trabeculectomy in eyes with a previously implanted glaucoma drainage device. A second AGV is a viable option in eyes with inadequate IOP levels after a primary AGV.

      PubDate: 2018-01-03T12:22:36Z
      DOI: 10.1016/j.ajo.2017.11.018
      Issue No: Vol. 186 (2018)
  • Use of Donors Predisposed by Corneal Collagen Cross-linking in Penetrating
           Keratoplasty for Treating Patients With Keratoconus
    • Authors: Ting Huang; Ruifen Ye; Chen Ouyang; Chao Hou; Yunwei Hu; Qianni Wu
      Abstract: Publication date: Available online 14 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Ting Huang, Ruifen Ye, Chen Ouyang, Chao Hou, Yunwei Hu, Qianni Wu

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.014
  • Progression of Primary Open Angle Glaucoma in Diabetic and Non-diabetic
    • Authors: Huiyuan Hou; Takuhei Shoji; Linda M. Zangwill; Sasan Moghimi; Luke J. Saunders; Kyle Hasenstab; Elham Ghahari; Patricia Isabel C. Manalastas; Tadamichi Akagi; Mark Christopher; Rafaella C. Penteado; Robert N. Weinreb
      Abstract: Publication date: Available online 13 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Huiyuan Hou, Takuhei Shoji, Linda M. Zangwill, Sasan Moghimi, Luke J. Saunders, Kyle Hasenstab, Elham Ghahari, Patricia Isabel C. Manalastas, Tadamichi Akagi, Mark Christopher, Rafaella C. Penteado, Robert N. Weinreb
      Purpose To compare the rates of visual field (VF) loss and retinal nerve fiber layer (RNFL) thinning in primary open angle glaucoma (POAG) patients with or without type 2 diabetes mellitus (DM). Design Cohort study. Methods A total of 197 eyes (55 eyes of 32 POAG patients with DM in POAG/DM group and 142 eyes of 111 age-matched POAG patients without DM in POAG/DM- group) were included from the Diagnostic Innovations in Glaucoma Study (DIGS). Type 2 DM participants were defined by self-report of DM history and use of anti-diabetic medication. The rates of VF loss and RNFL loss were compared in POAG eyes with and without DM using univariate and multivariable mixed effects models. Results The median (interquartile range) follow-up was 5.7 years (4.0, 6.4). The mean rate of global RNFL loss in the POAG/DM group was 2-fold slower than in the POAG/DM- group overall (-0.40 μm /year vs. -0.83 μm /year, respectively P = 0.01). Although a slower rate of VF mean deviation and pattern standard deviation loss was found in the POAG/DM group compared to the POAG/DM- group, the difference was not statistically significant. Conclusions POAG patients with treated type 2 DM, who had no detectable diabetic retinopathy, had significantly slower rates of RNFL thinning compared to those without diagnosed DM.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.02.002
  • Performance and Safety of a New Ab Interno Gelatin Stent in Refractory
           Glaucoma at 12 Months
    • Authors: Jeffrey W. Kalenak
      Abstract: Publication date: Available online 13 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Jeffrey W. Kalenak

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.031
  • Comparing treatment of acute retinal necrosis with either oral
           valaciclovir or intravenous aciclovir
    • Authors: Julijana Baltinas; Sue Lightman; Oren Tomkins-Netzer
      Abstract: Publication date: Available online 12 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Julijana Baltinas, Sue Lightman, Oren Tomkins-Netzer
      Purpose To compare the visual outcomes of patients with acute retinal necrosis (ARN) treated initially with intravenous aciclovir versus oral valaciclovir therapy. Design Retrospective, comparative, interventional case series. Methods 62 patients (68 eyes) with ARN, treated at Moorfields Eye Hospital (United Kingdom) between 1992 and 2016, were identified through the hospital’s electronic database. Exclusion criteria included insufficient patient records or follow-up (<150 days). 56 patients had unilateral ARN, while 6 had bilateral ARN. Patients who received intravenous aciclovir on diagnosis (n=33) were compared with patients treated with oral valaciclovir (n=29) across outcomes including best corrected visual acuity, retinal detachment, severe vision loss and other complications. The impact of adjunctive intravitreal antiviral and prophylactic barrier laser treatment was also assessed. Results Change in best corrected visual acuity was not significantly different for eyes treated initially with intravenous therapy versus oral therapy over 5 years of follow-up data (p=0.16). There was no difference in the rates of severe vision loss between the two groups (46% and 59%, respectively, p=0.18), or of those eyes retaining good vision (28% vs. 31%, respectively, p=0.80). Retinal detachment occurred in 63% of cases and did not differ across treatment groups (62% vs. 66%, respectively, p=0.67). Barrier laser and intravitreal therapy had no effect on retinal detachment rate in either group. Conclusion Oral valaciclovir is clinically equivalent to intravenous therapy in the management of ARN. Oral valaciclovir as an outpatient therapy—with or without intravitreal foscarnet—can therefore be considered as an acceptable alternative to inpatient therapy required for intravenous treatment.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.02.001
  • The Significance of Repeat Cultures in the Treatment of Severe Fungal
    • Authors: Kathryn J. Ray; N. Venkatesh Prajna; Prajna Lalitha; Revathi Rajaraman; Tiruvengada Krishnan; Sushila Patel; Manoranjan Das; Ranjeet Shah; Kavita Dhakhwa; Stephen D. McLeod; Michael E. Zegans; Nisha R. Acharya; Thomas M. Lietman; Jennifer Rose-Nussbaumer
      Abstract: Publication date: Available online 10 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Kathryn J. Ray, N. Venkatesh Prajna, Prajna Lalitha, Revathi Rajaraman, Tiruvengada Krishnan, Sushila Patel, Manoranjan Das, Ranjeet Shah, Kavita Dhakhwa, Stephen D. McLeod, Michael E. Zegans, Nisha R. Acharya, Thomas M. Lietman, Jennifer Rose-Nussbaumer
      PURPOSE To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. DESIGN Secondary analysis of randomized clinical trial data. SUBJECTS Patients presenting with a smear-positive filamentous fungal ulcer, visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). METHODS We compare the clinical outcomes of patients who had positive 6-day fungal cultures compared to those who did not, using backwards-stepwise regression with co-variates for all baseline clinical characteristics. MAIN OUTCOME MEASURES The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle corrected visual acuity (BSCVA), 3-month infiltrate and/or scar-size, and rate of re-epithelialization. RESULTS Patients who tested positive at their 6-day culture had twice the hazard of experiencing a corneal perforation or the need for therapeutic penetrating keratoplasty (P=0.002) than those who tested negative even after controlling for baseline ulcer characteristics. These patients also had on average 0.26 LogMAR lines worse BSCVA at 3-months (P=0.001). Culture positivity at day-6 was not a statistically significant predictor of 3-month infiltrate/scar-size (-0.24 mm1; P=0.45) or time to re-epithelialization (HR=.81; P=0.31). CONCLUSIONS Here we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.02.003
  • Is Corneal Arcus Independently Associated With Incident Cardiovascular
           Disease in Asians'
    • Authors: Masoumeh B. Masoumpour; Peyman Jafari
      Abstract: Publication date: Available online 9 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Masoumeh B. Masoumpour, Peyman Jafari

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.027
  • Use of Donors Predisposed by Corneal Collagen Cross-linking in Penetrating
           Keratoplasty for Treating Patients With Keratoconus
    • Authors: Sally Hayes; Keith M. Meek; Achyut Mukherjee
      Abstract: Publication date: Available online 9 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Sally Hayes, Keith M. Meek, Achyut Mukherjee

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2017.12.026
  • Ophthalmic Findings of Rosai-Dorfman Disease
    • Authors: Michael B. Choi; Diva R. Salomão; Wendy M. Smith; Jose S. Pulido; James A. Garrity
      Abstract: Publication date: Available online 9 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Michael B. Choi, Diva R. Salomão, Wendy M. Smith, Jose S. Pulido, James A. Garrity
      Purpose To describe the ophthalmic, pathologic, and BRAF V600E mutation status of Rosai-Dorfman Disease (RDD). Design Retrospective case series. Methods A retrospective review of all cases of RDD seen at Mayo Clinic from 1992 to 2016 identified patients with ophthalmic manifestations (n=8). Immunostain for BRAF and molecular studies for BRAFV600E mutation were performed on cases with tissue available. Results Of 76 patients with RDD, 15 had eye exams and, of those, 8 had ophthalmic manifestations (5 females and 3 males). In RDD patients with ophthalmic manifestations compared to RDD patients without ophthalmic manifestations, the median age in years was 42 (15-70) and 56 (32-79) (p=0.13) and median LogMAR visual acuity was 0.048 (0.000-1.824) and 0.000 (-0.124-0.301) (p=0.19), respectively. Of the 8 patients with ophthalmic manifestations, 4 had ocular involvement and 4 had orbital masses. Patients with ocular involvement had multi-organ disease including tracheal, aortic, renal, skeletal, and soft tissue lesions (n=4). Patients with orbital masses had no systemic involvement (n=2), skeletal involvement only (n=1), or multi-organ disease (n=1). BRAF immunostaining and molecular studies were negative in all available specimens (n=6). Conclusions In this series of patients with ophthalmic manifestations of RDD, those with ocular involvement had multi-organ disease while those with orbital masses had more limited systemic disease. Patients with ophthalmic manifestations tended to be younger and have worse visual acuity. Additionally, ophthalmic RDD does not seem to be associated with BRAF mutation.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.037
  • Association between Optic Nerve Head Deformation and Retinal
           Microvasculature in High Myopia
    • Authors: Mi Sun Sung; Tae Hee Lee; Hwan Heo; Sang Woo Park
      Abstract: Publication date: Available online 6 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Mi Sun Sung, Tae Hee Lee, Hwan Heo, Sang Woo Park
      Purpose To evaluate the retinal microvasculature of peripapillary and macular regions in highly myopic eyes and investigate the association between the vascular parameters and optic nerve head (ONH) deformation. Design Cross-sectional study Methods Seventy-one subjects with highly myopic eyes and 26 subjects with emmetropic eyes were included. Horizontal B-scan images of the ONH were obtained using optical coherence tomography (OCT) and horizontal tilt angles were measured. Integrated automated algorithms in the Avanti OCT angiography were used to quantify the peripapillary vessel density and area of the foveal avascular zone (FAZ) at the level of superficial and deep vascular networks. Association between horizontal disc tilt and the vascular parameters was evaluated. Results The mean axial length and horizontal tilt angle were 26.73 ± 0.63 mm and 9.77 ± 3.00° in the highly myopic group and 23.46 ± 0.55 mm and 5.95 ± 3.48° in the emmetropic group, respectively. Highly myopic eyes exhibited significantly lower average peripapillary vessel density (P = .010) and larger superficial and deep FAZs (P = .001 and P < .001, respectively) compared with emmetropic eyes. Linear regression analyses showed that horizontal tilt angle significantly correlated the average peripapillary vessel density (P = .037) and the areas of superficial (P < .001) and deep (P < .001) FAZs. Conclusions The retinal microvasculature was significantly different in highly myopic eyes according to the degree of horizontal optic disc tilt. In addition to peripapillary vessel density, FAZ can be affected by the degree of optic disc tilt.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.033
  • Chronic Ocular Sequelae of Stevens-Johnson Syndrome in Children: Long-term
           Impact of Appropriate Therapy on Natural History of Disease
    • Authors: Sayan Basu; Swapna S. Shanbhag; Arjun Gokani; Richa Kedar; Chirag Bahuguna; Virender S. Sangwan
      Abstract: Publication date: Available online 6 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Sayan Basu, Swapna S. Shanbhag, Arjun Gokani, Richa Kedar, Chirag Bahuguna, Virender S. Sangwan
      Purpose To describe the long-term ocular and visual morbidity in children with chronic sequelae of Stevens-Johnson Syndrome (SJS) and visual outcomes of various management strategies. Design Retrospective comparative case series. Methods This study included 568 eyes of 284 children with SJS who presented between 1990 and 2015. Affected eyes either received conservative therapy (n=440) or definitive management (n=128) including lid margin mucous membrane grafting (MMG), prosthetic replacement of the ocular surface ecosystem (PROSE) contact lenses, allogeneic limbal transplantation or keratoprosthesis using an algorithmic approach based on the severity of dryness and cause and extent of corneal damage. The primary outcome measure was best corrected visual acuity (BCVA). Results Two-thirds of patients presented more than a year after acute SJS, 99% without prior amniotic membrane grafting, with low-vision or blindness in 60% of eyes. Children 8-years or younger in age had significantly worse ocular and visual morbidity (P≤0.037). At 5-years of follow-up, definitive therapy significantly altered the natural history of the disease by improving BCVA and preventing the development or progression of keratopathy, as compared to conservative therapy (P≤0.002). In eyes with lid-related keratopathy, MMG was significantly more effective than PROSE, although both were significantly better than conservative therapy and the combination of MMG followed by PROSE provided the best results (P<0.0001). Conclusion Children receiving sub-optimal care during acute SJS presented later with severe ocular and visual morbidity. Timely therapy, particularly with PROSE and MMG in eyes with lid-related keratopathy changed the natural course and helped in preserving and improving vision.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.028
  • Vancomycin-associated hemorrhagic occlusive retinal vasculitis: a
           clinical-pathophysiological analysis
    • Authors: Bozho Todorich; Lisa J. Faia; Aristomenis Thanos; Mitual Amin; Robert Folberg; Jeremy D. Wolfe; Krista M. Todorich; Efthemios Raphtis; Alan J. Ruby; George A. Williams; Tarek S. Hassan
      Abstract: Publication date: Available online 6 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Bozho Todorich, Lisa J. Faia, Aristomenis Thanos, Mitual Amin, Robert Folberg, Jeremy D. Wolfe, Krista M. Todorich, Efthemios Raphtis, Alan J. Ruby, George A. Williams, Tarek S. Hassan
      Purpose To derive novel insights into the pathophysiology of vancomycin-related hemorrhagic occlusive retinal vasculopathy (HORV) through a careful clinicopathologic correlation. Methods and study design: We retrospectively reviewed the clinical and pathologic course of two consecutive patients who developed HORV. The clinical history, multimodal imaging, ultrasound biomicroscopy (UBM), intraoperative and histological findings are reported. Results Both patients presented with decreased vision and eye pain within 1 week following otherwise uncomplicated cataract extraction and were diagnosed with HORV after endophthalmitis was ruled out. Both patients presented with significant ocular discomfort that progressively worsened, and both experienced a dismal visual outcome despite early aggressive medical and surgical therapy. One patient requested enucleation for a blind and painful eye. Upon histologic examination of this eye, the iris and ciliary body appeared to be infarcted with separation of the iris and ciliary epithelia from their adjacent stromal components. These findings were corroborated by UBM of the second patient. Histological examination of the posterior segment demonstrated severe hemorrhagic necrosis of the neurosensory retina and an occlusive non-arteritic vasculopathy of the retina and choroid. The choroid was thickened by prominent non-granulomatous chronic inflammation accompanied by a glomeruloid proliferation of small vessels. The inflammatory infiltrate was almost exclusively confined to the choroid and consisted of predominantly T-cells. There was conspicuous absence of inflammatory cells in the retina and no histologic evidence of leukocytoclastic vasculitis. Conclusions HORV is a rare condition that can lead to profound vision loss. Significant ocular pain can be a presenting sign of HORV in cases with severe iris and ciliary body ischemia. Although it has been suggested that HORV is a form of leukocytoclastic retinal vasculitis, the histological findings herein indicate that the pathophysiology is more complex. It is grounded in a necrotizing retinal vasculopathy in the absence of retinal vasculitis, chronic non-granulomatous choroiditis, and an unusual glomeruloid proliferation of endothelial cells in the choroid and elsewhere in the eye.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.030
  • Jalili Syndrome: Cross-sectional and Longitudinal Features of Seven
           Patients with Cone-Rod Dystrophy and Amelogenesis Imperfecta
    • Authors: Nashila Hirji; Patrick D. Bradley; Shuning Li; Ajoy Vincent; Mark E. Pennesi; Akshay S. Thomas; Elise Heon; Aparna Bhan; Omar A. Mahroo; Anthony Robson; Chris F. Inglehearn; Anthony T. Moore; Michel Michaelides
      Abstract: Publication date: Available online 5 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Nashila Hirji, Patrick D. Bradley, Shuning Li, Ajoy Vincent, Mark E. Pennesi, Akshay S. Thomas, Elise Heon, Aparna Bhan, Omar A. Mahroo, Anthony Robson, Chris F. Inglehearn, Anthony T. Moore, Michel Michaelides

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.029
  • Visual Outcomes Following Bilateral lmplantation of Two Diffractive
           Trifocal Intraocular Lenses in 10 084 Eyes
    • Authors: Rafael Bilbao-Calabuig; Andrea Llovet-Rausell; Julio Ortega-Usobiaga; Mercedes Martínez-del-Pozo; Fernando Mayordomo-Cerdá; Celia Segura-Albentosa; Julio Baviera; Fernando Llovet-Osuna
      Abstract: Publication date: Available online 3 February 2018
      Source:American Journal of Ophthalmology
      Author(s): Rafael Bilbao-Calabuig, Andrea Llovet-Rausell, Julio Ortega-Usobiaga, Mercedes Martínez-del-Pozo, Fernando Mayordomo-Cerdá, Celia Segura-Albentosa, Julio Baviera, Fernando Llovet-Osuna

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.010
  • Trends in corneal transplantation from 2001 to 2016 in Germany: A report
           of the DOG-Section Cornea and its Keratoplasty Registry
    • Authors: E. Flockerzi; P. Maier; D. Böhringer; H. Reinshagen; F. Kruse; C. Cursiefen; T. Reinhard; G. Geerling; N. Torun; B. Seitz
      Abstract: Publication date: Available online 2 February 2018
      Source:American Journal of Ophthalmology
      Author(s): E. Flockerzi, P. Maier, D. Böhringer, H. Reinshagen, F. Kruse, C. Cursiefen, T. Reinhard, G. Geerling, N. Torun, B. Seitz
      Purpose The purpose of this retrospective panel study was to provide an overview of absolute numbers, trends in the types of and indications for corneal transplantation in Germany from 2001 to 2016. Methods A questionnaire about absolute numbers, types of transplantation and indications was sent to 111 ophthalmological departments in Germany out of which 94 (85%) provided their data. Results Since the year 2001, the number of corneal transplantations has increased by 1.5 fold from 4730 penetrating keratoplasties (PKPs) in 2001 to 7325 penetrating and lamellar keratoplasties in 2016. The shift from penetrating to lamellar procedures began in 2006. In 2014, lamellar procedures (231 (4%) anterior and 2883 (49%) posterior lamellar keratoplasties) surpassed PKPs (2721, 47%) for the first time. Main indications for keratoplasty in Germany (2016) are Fuchs‘ endothelial corneal dystrophy (46%), pseudophakic corneal decompensation (bullous keratopathy, 13%), repeated keratoplasty after graft failure (11%), keratoconus (8%) and corneal scarring (6%; others: 16%). The number of Descemet membrane endothelial keratoplasties (DMEKs) was twelve times higher (3850, 53%) than Descemet’s stripping automated endothelial keratoplasties (DSAEKs, 319, 4.4%) in 2016. The proportion of deep anterior lamellar keratoplasties (DALKs) never exceeded 6% (269 in 2011). Conclusions The number of keratoplasties in Germany has increased from 2001 to 2016. Since 2014, posterior lamellar keratoplasties have surpassed PKPs. There was a constant increase of DMEKs with a twelvefold higher number compared to DSAEKs in 2016. The shorter recovery time after DMEK seems to contribute to the trend towards earlier operative intervention in corneal endothelial diseases.

      PubDate: 2018-02-15T10:12:44Z
      DOI: 10.1016/j.ajo.2018.01.018
  • Reproducibility of Vessel Density, Fractal Dimension, and Foveal Avascular
           Zone Using 7 Different Optical Coherence Tomography Angiography Devices
    • Authors: Federico Corvi; Marco Pellegrini; Stefano Erba; Mariano Cozzi; Giovanni Staurenghi; Andrea Giani
      Pages: 25 - 31
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Federico Corvi, Marco Pellegrini, Stefano Erba, Mariano Cozzi, Giovanni Staurenghi, Andrea Giani
      Purpose To evaluate the reproducibility of parafoveal microvascular anatomy of 7 different optical coherence tomography angiography (OCT-A) devices by comparing vessel density (VD), fractal dimension (FD), and foveal avascular zone (FAZ) of superficial and deep capillary plexus in healthy volunteers. Design Reliability analysis. Methods Consecutive healthy volunteers presenting at the Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan in the same clinic visit were imaged by 7 different OCT-A devices: Optovue RTVue XR Avanti (Optovue, Inc, Fremont, California, USA), prototype Spectralis OCT-A (Spectralis; Heidelberg Engineering, Heidelberg, Germany), AngioPlex (Cirrus 5000 HD-OCT; Carl Zeiss Meditec, Inc, Dublin, California, USA), prototype PlexElite (Carl Zeiss Meditec), RS-3000 Advance (Nidek, Gamagori, Japan), OCT-HS100 (Canon, Tokyo, Japan), and Revo NX (Optopol Technology SA, Zawiercie, Poland). OCT-A examinations were performed using a 3 × 3 mm volume scan pattern centered on the fovea. Mean VD, FD, and FAZ values between the instruments were compared. Results The 7 different devices presented measurements with different mean values, with only a limited number of comparisons not significantly different between the instruments. Moreover, Bland-Altman analysis revealed that the limits of agreement for all the comparisons were not acceptable. Regression analysis was used in the development of tables to compare various devices, despite which large standard errors were found for both intercepts and slope conversion values. Conclusions Our results suggest that the comparison between instruments is nearly impossible and the set of measurements from the various instruments are not interchangeable regarding VD, FD, and FAZ for both the superficial and deep capillary plexus.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.11.011
      Issue No: Vol. 186 (2017)
  • Efficacy and Safety of Low-Dose Iodine Plaque Brachytherapy for
           Juxtapapillary Choroidal Melanoma
    • Authors: Patrick Oellers; Yvonne M. Mowery; Bradford A. Perez; Sandra Stinnett; Pradeep Mettu; Lejla Vajzovic; Kim Light; Beverly A. Steffey; Jing Cai; Jonathan J. Dutton; Edward G. Buckley; Edward C. Halperin; Lawrence B. Marks; David G. Kirsch; Prithvi Mruthyunjaya
      Pages: 32 - 40
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Patrick Oellers, Yvonne M. Mowery, Bradford A. Perez, Sandra Stinnett, Pradeep Mettu, Lejla Vajzovic, Kim Light, Beverly A. Steffey, Jing Cai, Jonathan J. Dutton, Edward G. Buckley, Edward C. Halperin, Lawrence B. Marks, David G. Kirsch, Prithvi Mruthyunjaya
      Purpose To evaluate low- vs high-dose plaque brachytherapy for juxtapapillary choroidal melanoma. Design Retrospective interventional case series. Methods Setting : Single institution. Study Population : Forty-seven patients with juxtapapillary choroidal melanoma. Intervention : Iodine-125 plaque brachytherapy. Eyes were divided into apex low-dose (LD) and high-dose (HD) groups (≤ or > median apex dose 84.35 Gy). Main outcome measures were time to distant failure, local failure, death, enucleation, radiation retinopathy, optic neuropathy, and best-corrected visual acuity (BCVA). Results Freedom from distant failure rates were 96% and 95% in apex LD and HD groups at 5 years and 77% and 95% at 10 years, respectively (P = .84). Freedom from local failure rates were 90% in the apex LD group vs 89% in the HD group at 5 and 10 years (P = .96). Apex LD and HD groups did not differ for time to death or enucleation. Five- and 10-year freedom from radiation retinopathy and optic neuropathy rates were higher in the apex LD than HD group. Loss of ≥3 BCVA lines, final BCVA 20/40 or better, and final BCVA 20/200 or worse were more favorable in the 5 mm LD compared to HD group. Visual acuity outcomes did not differ between apex LD and HD groups. Conclusions Low-dose iodine-125 plaque brachytherapy (67.5–81 Gy at tumor apex) provides safe and effective tumor control for juxtapapillary choroidal melanoma and may be associated with reduced radiation toxicity. Larger trials are needed to determine the optimal therapeutic dose for juxtapapillary choroidal melanoma.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.11.008
      Issue No: Vol. 186 (2017)
  • Corneal Stroma Enhancement With Decellularized Stromal Laminas With or
           Without Stem Cell Recellularization for Advanced Keratoconus
    • Authors: Jorge L. Alió del Barrio; Mona El Zarif; Albert Azaar; Nehman Makdissy; Charbel Khalil; Walid Harb; Ibrahim El Achkar; Ziad Abdul Jawad; María P. de Miguel; Jorge L. Alió
      Pages: 47 - 58
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Jorge L. Alió del Barrio, Mona El Zarif, Albert Azaar, Nehman Makdissy, Charbel Khalil, Walid Harb, Ibrahim El Achkar, Ziad Abdul Jawad, María P. de Miguel, Jorge L. Alió
      Purpose This phase 1 study seeks to preliminarily evaluate the safety and efficacy of decellularized human corneal stromal lamina transplantation with or without autologous adipose-derived adult stem cell recellularization within the corneal stroma of patients with advanced keratoconus. Design Phase 1 clinical trial. Methods Femtosecond-assisted 120-μm thickness and 9-mm diameter laminas were obtained from the anterior stroma of human donor corneas and decellularized with a sodium dodecyl sulfate solution. Autologous adipose-derived adult stem cells were obtained by elective liposuction and cultured onto both sides of the lamina. Five patients received the decellularized lamina alone and 4 patients the recellularized lamina into a femtosecond-assisted 9.5-mm diameter lamellar pocket under topical anesthesia. The total duration of follow-up was 6 months. Results No case showed clinical haze or scarring by month 3. Six months after surgery, patients showed a general improvement of all visual parameters, with a mean unaided visual acuity from 0.109 to 0.232 (P = .05) and corrected distance visual acuity from 0.22 to 0.356 (P = .068). Refractive sphere improved in all patients (from −4.55 diopters [D] to −2.69 D; P = .017), but refractive cylinder remained stable (from −2.83 to −2.61; P = .34). An improvement tendency of all anterior keratometric values was observed. A mean improvement of 120 μm in all thickness parameters was confirmed (P = .008), as well as an improvement in the spherical aberration (P = .018), coma (P = .23) and total higher order aberrations (P = .31). No significant differences among groups were detected. Conclusions Decellularized human corneal stromal laminas transplantation seems safe and moderately effective for advanced keratoconus. Potential benefits of its recellularization with autologous adipose-derived adult stem cells remains unclear.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.10.026
      Issue No: Vol. 186 (2017)
  • Anterior Segment Dimensions Following Laser Iridotomy in Acute Primary
           Angle Closure and Fellow Eyes
    • Authors: Sasan Moghimi; Faezeh Bijani; Rebecca Chen; Mehdi Yasseri; Mingguang He; Shan C. Lin; Robert N. Weinreb
      Pages: 59 - 68
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Sasan Moghimi, Faezeh Bijani, Rebecca Chen, Mehdi Yasseri, Mingguang He, Shan C. Lin, Robert N. Weinreb
      Purpose To compare the change in anterior segment morphology after laser peripheral iridotomy (LPI) in acute primary angle closure (APAC) and their fellow eyes. Design Prospective, fellow eye–matched case series. Methods In this study 42 individuals with unilateral episode of APAC were enrolled and the anterior segment optical coherence tomography (ASOCT) images were obtained in both eyes at baseline and at 6 weeks after LPI. A linear mixed-effects model was used to compare changes in anterior chamber and angle variables with consideration of laterality as the random effect and pupil diameter as the fixed effect. Results APAC eyes had smaller angle parameters (P = .013 for all), less central anterior chamber depth (cACD) (P < .001), and lower anterior chamber area (ACA) (P < .001), as well as greater lens vault (LV) (P = .007), compared with fellow eyes. LPI resulted in angle widening with a significant increase in opening distance (P < .01 for all) in both APAC and fellow eyes. cACD (P = .003) and ACA (P < .001) increased and LV (P = .002) decreased in APAC eyes. However, there was no significant change in cACD (P = .190) and LV (P = .430) in fellow eyes. In both APAC eyes and fellow eyes, iris curvature decreased after LPI (P < .001). The changes in angle parameters, ACA, and iris curvature were not significantly different between the 2 groups. Conclusion In APAC eyes and their fellow eyes, LPI resulted in significant anterior chamber angle widening and increased anterior chamber area. In APAC eyes, the iris flattened, cACD deepened, and the lens shifted posteriorly after resolution of the attack. However, in fellow eyes, the increase in ACA was mainly owing to decreased iris curvature.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.11.013
      Issue No: Vol. 186 (2017)
  • Leadership of United States Academic Departments of Ophthalmology:
           Chairperson Characteristics, Accomplishments, and Personal Insights
    • Authors: Gad Dotan; Hanya M. Qureshi; Steven S. Saraf; Deborah A. Darnley-Fisch
      Pages: 69 - 76
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Gad Dotan, Hanya M. Qureshi, Steven S. Saraf, Deborah A. Darnley-Fisch
      Purpose To report on the characteristics, accomplishments, and past experiences of current academic ophthalmology department chairs. Design Cross-sectional study. Methods Setting : A confidential online survey. Study Population : Total of 111 chairs of US academic ophthalmology departments. Main Outcome Measures : Chairs' general characteristics, training/former positions held, academic accomplishments, previous organization/committee involvement, motivation/insight, and overall work satisfaction. Results Fifty-five chair responses were received (96% male, mean age 57 years, mean term 7 years). The majority were American medical graduates (93%), full professors of ophthalmology (93%), and permanent chairs (96%). All completed their residency in the US and 96% completed a fellowship (25% vitreoretinal surgery, 22% cornea and external disease, and 20% glaucoma). On average, chairs authored 98 peer-reviewed articles, 2 books, and 11 book chapters. They were also significantly involved in peer-reviewed journal literature, serving as editors (20%), associate editors (18%), or editorial board members (60%). The majority of chairs indicated they decided to seek their position late in their career, having already become a full (33%) or associate professor (26%), primarily owing to a desire to build and promote an academic ophthalmology department (61%). Chairs regarded their experience as head of service as most important for their current performance as department heads. Their principal advice to aspiring ophthalmology chairs was to focus on developing skills as a clinician, researcher, and educator (“triple threat”). Conclusions Overall, academic department chairs are accomplished leaders in ophthalmology and prolific authors with an established academic record. Chairs regarded their previous leadership roles within the department as invaluable to their effectiveness as chair.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.10.024
      Issue No: Vol. 186 (2017)
  • Osseous and Adipocytic Differentiations in the Intraocular Lens and
    • Authors: Frederick A. Jakobiec; Lina Ma; Natalie Wolkow; J. Douglas Cameron; Amanda C. Maltry
      Pages: 77 - 88
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Frederick A. Jakobiec, Lina Ma, Natalie Wolkow, J. Douglas Cameron, Amanda C. Maltry
      Purpose To analyze 3 unusual mesenchymal transformations within the eye: adipose or osseous metaplasia of the lens and adipose tissue in the vitreous cavity. Design Observational case series. Methods Reevaluation of clinicopathologic diagnoses and histopathologic findings in sections stained with hematoxylin-eosin, periodic acid–Schiff (PAS) reaction, and Masson trichrome method. Results The 3 cases of mesenchymal transformation occurred in microphthalmic eyes with persistent hyperplastic primary vitreous (more recently termed persistent fetal vasculature). In 1 case there was total lens replacement with lamellar bone; in another, total replacement of the crystalline lens by adipose tissue; and in a third, an anomalous pocket of adipose tissue in the central vitreous. Multifocal remnants of the lens capsule were seen in the osseous case but were absent from the adipocytic cases. The vitreous adipose tissue was surrounded by an elaborate capillary plexus with an empty, collapsed PAS-positive lens capsule in the pupillary region. Anterior pigmented neuroectodermal disorganization, dysgenesis of angle structures, and a hypoplastic or disorganized iris were also observed in the 3 cases. Conclusions After review of the literature, it appears that lenticular osseous replacement occurs more often than adipocytic. In addition to vascularization of the lens through a capsular dehiscence, other causes are explored, including direct epithelial-mesenchymal transformations of the lens epithelium or, less likely, of the disorganized adjacent neuroectoderm. The focus of vitreous adipose tissue may represent a transformed luxated lens extruded from its capsule, which was left behind in the pupillary zone.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.11.014
      Issue No: Vol. 186 (2017)
  • A Longitudinal Analysis of Peripapillary Choroidal Thinning in Healthy and
           Glaucoma Subjects
    • Authors: Rusdeep S. Mundae; Linda M. Zangwill; Sami W. Kabbara; Naama Hammel; Christopher Bowd; Felipe A. Medeiros; Christopher A. Girkin; Jeffrey M. Liebmann; Robert N. Weinreb; Akram Belghith
      Pages: 89 - 95
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Rusdeep S. Mundae, Linda M. Zangwill, Sami W. Kabbara, Naama Hammel, Christopher Bowd, Felipe A. Medeiros, Christopher A. Girkin, Jeffrey M. Liebmann, Robert N. Weinreb, Akram Belghith
      Purpose To evaluate the rate of peripapillary choroidal thinning in glaucoma patients and healthy controls using spectral domain optical coherence tomography. Design Cohort study. Methods Participants from the multicenter African Descent and Glaucoma Evaluation Study and Diagnostic Innovations in Glaucoma Study were included. The San Diego Automated Segmentation Algorithm was used to automatically segment and measure peripapillary choroidal thickness (PCT) from circle scans centered on the optic nerve head. The rate of PCT thinning was calculated using mixed effects models. Results Two hundred ninety-seven eyes with a median follow-up of 2.6 years were included. At baseline, the global mean PCT was significantly thinner in glaucoma patients than healthy control subjects (141.7 ± 66.3 μm vs 155.7 ± 64.8 μm, respectively; P < .001). However, when age was included in the model, this difference was no longer significant (P = .38). Both healthy controls and glaucoma patients had a significant decrease in mean (95% confidence interval) PCT change over time (−2.18 [−2.97 to −1.40 μm/year] and −1.88 [−3.08 to −0.67 μm/year], respectively) and mean PCT percent change over time (−3.32% [−4.36 to −2.27 μm/year] and −2.85% [−4.64 to −0.99 μm/year], respectively). No significant difference was found between healthy control subjects and glaucoma patients in the mean rate of PCT change (P = .28) or PCT percentage change over time (P = .23). Conclusions The rate of peripapillary choroidal thinning was not significantly different between healthy and glaucoma eyes during this relatively short follow-up period. Longer follow-up is needed to determine whether monitoring the rate of PCT change has a role in glaucoma management.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.10.025
      Issue No: Vol. 186 (2017)
  • A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in
           Children Aged 13 to 16 Years With Amblyopia
    • Authors: Vivian M. Manh; Jonathan M. Holmes; Elizabeth L. Lazar; Raymond T. Kraker; David K. Wallace; Marjean T. Kulp; Jennifer A. Galvin; Birva K. Shah; Patricia L. Davis
      Pages: 104 - 115
      Abstract: Publication date: February 2018
      Source:American Journal of Ophthalmology, Volume 186
      Author(s): Vivian M. Manh, Jonathan M. Holmes, Elizabeth L. Lazar, Raymond T. Kraker, David K. Wallace, Marjean T. Kulp, Jennifer A. Galvin, Birva K. Shah, Patricia L. Davis
      Purpose To compare visual acuity (VA) improvement in teenagers with amblyopia treated with a binocular iPad game vs part-time patching. Methods One hundred participants aged 13 to <17 years (mean 14.3 years) with amblyopia (20/40 to 20/200, mean ∼20/63) resulting from strabismus, anisometropia, or both were enrolled into a randomized clinical trial. Participants were randomly assigned to treatment for 16 weeks of either a binocular iPad game prescribed for 1 hour per day (n = 40) or patching of the fellow eye prescribed for 2 hours per day (n = 60). The main outcome measure was change in amblyopic eye VA from baseline to 16 weeks. Results Mean amblyopic eye VA improved from baseline by 3.5 letters (2-sided 95% confidence interval [CI]: 1.3–5.7 letters) in the binocular group and by 6.5 letters (2-sided 95% CI: 4.4–8.5 letters) in the patching group. After adjusting for baseline VA, the difference between the binocular and patching groups was −2.7 letters (95% CI: −5.7 to 0.3 letters, P = .082) or 0.5 lines, favoring patching. In the binocular group, treatment adherence data from the iPad device indicated that only 13% of participants completed >75% of prescribed treatment. Conclusions In teenagers aged 13 to <17 years, improvement in amblyopic eye VA with the binocular iPad game used in this study was not found to be better than patching, and was possibly worse. Nevertheless, it remains unclear whether the minimal treatment response to binocular treatment was owing to poor treatment adherence or lack of treatment effect.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.11.017
      Issue No: Vol. 186 (2017)
  • Long-term Progression of Type 1 Neovascularization in Age-related Macular
           Degeneration Using Optical Coherence Tomography Angiography
    • Authors: David Xu; Juan Pablo Dávila; Mansour Rahimi; Carl B. Rebhun; A. Yasin Alibhai; Nadia K. Waheed; David Sarraf
      Abstract: Publication date: Available online 18 December 2017
      Source:American Journal of Ophthalmology
      Author(s): David Xu, Juan Pablo Dávila, Mansour Rahimi, Carl B. Rebhun, A. Yasin Alibhai, Nadia K. Waheed, David Sarraf
      Purpose To analyze the long-term growth patterns of type 1 neovascularization (NV) in eyes with age-related macular degeneration (AMD) receiving anti-vascular endothelial growth factor (VEGF) therapy. Design : Retrospective cohort study. Methods Patients were enrolled from two eye centers and underwent optical coherence tomography angiography (OCTA) imaging with follow-up greater than 1 year. Choroidal neovascularization (CNV) was manually segmented on OCTA images and compared between time points. CNV growth was sub-divided into three categories based on OCTA area measurement: CNV doubling, modest growth of less than 50%, and shrinkage. These growth rates were correlated with OCTA morphologic features. Results : Forty-one eyes were analyzed. Mean CNV area was 1.60 ± 1.84 mm2 at baseline and 1.80 ± 1.84 mm2 at 1 year. Thirty-three eyes (80%) displayed an increase in CNV area at 1 year with a mean increase of 0.20 ± 0.38 mm2 (p=0.001). 11 eyes (27%) underwent CNV doubling, 19 eyes (46%) illustrated modest growth, and 6 (15%) showed shrinkage. Anatomic features including a capillary fringe (odds ratio [OR]=5.3, p=0.036) and immature lesion morphology (OR=4.2, p=0.015) were significantly associated with CNV doubling. CNV growth occurred in three predominant patterns: “symmetric” growth, “asymmetric” growth, and “finger-like projections” which reflected the orientation of expansion of CNV. “Symmetric” and “asymmetric” growth together correlated with greater frequency of CNV doubling (OR=15, p=0.0048). Conclusion OCTA provides noninvasive measurement of the area of neovascular lesions in AMD. Sustained growth of type 1 NV can be identified in the majority of lesions (80%) that display characteristic patterns of progression despite ongoing anti-VEGF therapy.

      PubDate: 2017-12-24T11:54:27Z
      DOI: 10.1016/j.ajo.2017.12.005
  • Longitudinal Change in Central Corneal Thickness in the Tema Eye Survey
    • Authors: Jean-Claude Mwanza; Samantha E. Tulenko; Donald L. Budenz; Elizabeth Mathenge; Leon H. Herndon; Hanna Y. Kim; Alyson Hall; Graham Hay-Smith; Alexander Spratt; Keith Barton
      Abstract: Publication date: Available online 12 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Jean-Claude Mwanza, Samantha E. Tulenko, Donald L. Budenz, Elizabeth Mathenge, Leon H. Herndon, Hanna Y. Kim, Alyson Hall, Graham Hay-Smith, Alexander Spratt, Keith Barton
      Purpose To determine the change and rate of change in central corneal thickness (CCT) and their determinants. Design Longitudinal observational population-based study. Methods 758 normal and 58 glaucomatous subjects underwent complete eye examination, with CCT measurements at two separate visits. Change and rate of change in CCT were determined. Univariate and multivariate linear regression analyses were performed to determine the factors associated with change and rate of change. Results The mean follow-up duration was 8.4 ± 0.7 years. The overall change was -8.9 ± 16.7 μm in OD and -9.8 ± 16.2 μm in OS, both P < .0001. Changes in glaucomatous and normal subjects were -14.1 ± 2.2 μm vs. -8.6 ± 0.6 μm in OD (P = .02) and -14.5 ± 2.2 μm vs. -9.5 ± 0.6 μm in OS (P = .03), respectively. The overall rate of thinning was -1.1 μm/year (OD) and -1.2 μm/year (OS). Rates in glaucomatous and normal were -1.7 ± 0.3 vs. -1.0 ± 0.1 μm/year in OD (P = .02) and -1.7 ± 0.3 vs. -1.1 ± 0.1 μm/year in OS (P = .03), respectively. Change and rate of change were associated with baseline CCT (ß = -0.1 to -0.09 and -0.011, respectively, all P < .001) and glaucoma (ß = -6.8 to -5.6, P ≤ .009 and -0.75 to -0.69, P ≤ .007, respectively). Conclusion CCT decreased significantly over time. The change and rate of change were greater in glaucomatous than normal eyes, and greater than described in cross-sectional studies.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.11.002
  • Quantifying the Rate of Ellipsoid Zone Loss in Stargardt Disease
    • Authors: Cindy X. Cai; Jacob G. Light; James T. Handa
      Abstract: Publication date: Available online 7 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Cindy X. Cai, Jacob G. Light, James T. Handa
      PURPOSE To determine a reliable method of using the ellipsoid zone (EZ) on optical coherence tomography (OCT) to track disease progression in Stardgardt disease (STGD). DESIGN retrospective reliability study METHODS STGD patients with genetically confirmed ABCA4 gene mutations seen at the Wilmer Eye Institute with follow-up visits separated by at least 12 months were identified. Spectral domain optical coherence tomography (SD-OCT) macula volume scans centered at the fovea and fundus autofluorescence (FAF) images were obtained. The area of EZ loss was calculated from the SD-OCT and the area of RPE loss from the FAF. Scans were re-analyzed by the primary grader to assess intra-grader reliability, and re-analyzed by a second grader to assess inter-grader reliability. RESULTS 16 STGD patients (total of 31 eyes) were followed for a mean of 2 years (range 1-4.7 years). The mean rate EZ loss, 0.31± 0.31mm2/year, was similar to the average rate of RPE loss, 0.33±0.38mm2/year. The average area of EZ loss at the initial examination, 4.18±1.9mm2/year, was larger than the initial area of RPE loss, 2.25±1.66mm2 (p < 0.01). The absolute difference of the area of EZ loss on test-retest for the first grader was 0.12±0.10mm2, and between graders 0.21±0.21mm2. The intraclass correlation (ICC) of both intra-grader as well as inter-grader reliability for EZ loss was excellent at 0.99. CONCLUSIONS Tracking the area of EZ loss on SD-OCT macular volume scans longitudinally is a reliable way of monitoring disease progression in STGD. This could be used as a sensitive anatomic outcome measure in clinical trials related to STGD.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.10.032
  • Inter-observer agreement among uveitis experts on uveitic diagnoses: the
           Standardization of Uveitis Nomenclature (SUN) experience
    • Authors: Douglas A. Jabs; Andrew Dick; John T. Doucette; Amod Gupta; Susan Lightman; Peter McCluskey; Annabelle A. Okada; Alan G. Palestine; James T. Rosenbaum; Sophia M. Saleem; Jennifer Thorne; Brett Trusko
      Abstract: Publication date: Available online 6 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Douglas A. Jabs, Andrew Dick, John T. Doucette, Amod Gupta, Susan Lightman, Peter McCluskey, Annabelle A. Okada, Alan G. Palestine, James T. Rosenbaum, Sophia M. Saleem, Jennifer Thorne, Brett Trusko
      Purpose To evaluate the interobserver agreement among uveitis experts on the diagnosis of the specific uveitic disease. Design Inter-observer agreement analysis Methods Five committees, each of 9 individuals, working in parallel, reviewed cases from a preliminary database of 25 uveitic diseases, collected by disease, and voted independently online whether the case was the disease in question or not. The agreement statistic, κ, was calculated for the 36 pairwise comparisons for each disease, and a mean κ was calculated for each disease. Following the independent online voting, committee consensus conference calls, using nominal group techniques, reviewed all cases not achieving supermajority agreement (>75%) on the diagnosis in the online voting to attempt to arrive at a supermajority agreement. Results A total of 5766 cases for the 25 diseases were evaluated. The overall mean κ for the entire project was 0.39 with disease-specific variation from 0.23 to 0.79. After the formalized consensus conference calls to address cases which did not achieve supermajority agreement in the online voting, supermajority agreement overall was reached on ∼99% of cases with disease-specific variation from 96 to 100%. Conclusions Agreement among uveitis experts on diagnosis is moderate at best but can be improved by discussion among them. These data suggest the need for validated and widely-used classification criteria in the field of uveitis.
      Teaser Agreement among uveitis experts on the diagnosis of 5766 cases for 25 diseases was moderate (overall mean κ=0.39), suggesting that groups of patients reported in the literature may not always be comparable. After formalized consensus conference calls, agreement was reached on 99% of cases, implying that validated and widely-used classification criteria for the uveitides may improve this situation.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.10.028
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